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HomeMy WebLinkAboutAge_Fallon �. "'"i APPLICATION FOR SENIOR COUNTY TOWNSHIP YEAR a, ':-,, i= PROPERTY TAX BENEFITS E� i State Form 43708(R19/7-25) • � © 2-o 2 � 'e�B Prescribed by the Department of Local Government FinanceI { Information contained in this document is CONFIDENTIAL pAti nt ItolC 202535-9. Instructions: To be filed in person or by mail with the county auditor of the county where the property is located. Filing Date: Form must be completed,signed,and jflt�/ccK3ty;r,z,:c;• ., tmarked by January 15 of the calendar year in which the property taxes are first due p }(pIFyOUNTY AU©ITOR See reverse side for additional instructions and qualifications. Type of Benefit Requested(Please chec all that apply) Over 65 Credit Over 65 Circuit Breaker Credit Name of Applicant(owner or contr c uyer) If Owned with Joint Tenant or Tenant in Common,Indicate with Whom ❑Yes ❑No If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? ❑Yes ❑No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least One(1)Year before Claiming Credit? ❑Yes ❑No Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question: Real Property ❑Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number C'1- • �6^ 12'0 1— •43*\-002.011A— 02S Did Applicant qualify for the homestead standard deduction in the preceding year(or was applicant married at the time of death to a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately 0 Yes preceding calendar year)and does Applicant qualify for the homestead standard deduction in the current year? 1 XNo Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due 8 Payable? Yes ❑No $ I/We certify under penalty of perjury that the above and foregoing information is true and correct ature of Appli Date(month, ay,rar) 1 c1�1 (1 ),C)2 r— • . A d ss o pplicant( mber and street,city,state,and ZIP code) - 50k E ot,L, S-k, - Dn— Ltd 69-1 . Signature of Authorized Representative Dale(month,day,year) • Address of Authorized Representative(number and street,city,state,and ZIP code) Signature of County Auditor Date(mont ,day,year) c�v� \l n� g I `?�2� DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer